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General NPI Number Information
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NPI Number | 1376890020
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Entity Type | Organization
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Legal Business Name | PENINUSLA EMERGENCY PHYSICIAN
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 3000 COLISEUM DR
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City | HAMPTON
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State | VA
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Zip | 23666-5963
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Country | US
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Telephone | 757-736-2008
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Fax |
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Provider Business Mailing Address
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Address Line | 11828 CANON BLVD STE E
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2554
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Country | US
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Telephone | 757-599-4922
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CHRISTOPHER BAKER
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Credential | M.D.
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Telephone | 757-599-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | F0712694
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License Number State | VA
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